Optimal doses are unknown, but studies have demonstrated children require higher mg/kg doses compared with adults to achieve similar voriconazole exposure.
IV/PO: 9 mg/kg/dose every 12 hours; maximum single dose: 350 mg
Loading dose IV: 6 mg/kg/DOSE every 12 hours for 2 doses on Day 1
Maintenance dose IV: 4 mg/kg/DOSE every 12 hoursOral dose (<40 kg): Optional loading dose of 200 mg/DOSE every 12 hours for 1 day followed by 100 mg/DOSE every 12 hours as maintenance; maximum 300 mg/day. Oral dose (≥40 kg): Optional loading dose of 400 mg/DOSE every 12 hours for 1 day followed by 200 mg/DOSE every 12 hours as maintenance, Maximum 600 mg/day.
Adjust dose in hepatic impairment
IV formulation contains sulfobutyl ether beta-cyclodextrin (SBECD) which may accumulate in renal insufficiency.
Renally cleared, requires dosage adjustment with changes in renal function.
Consult a pharmacist for renal dosing.
In most patients, oral therapy has not been recommended as initial therapy for treatment; it has been recommended to convert parenteral to oral therapy only after significant clinical improvement has been observed
In pediatric patients <12 years, bioequivalence between the oral tablet and suspension has not been determined; due to possible shortened gastric transit time in infants and children, absorption of tablets may be different than adults; it is recommended that infants and children <12 years only receive oral suspension formulation.
Candida infections both mucocutaneous and invasive - i.e. Candidemia
Antifungal prophylaxis in immunocompromised
Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity (discuss with ID)
Monitor QTc interval in patients at elevated risk
Monitor hepatic profile
Hepatic enzyme abnormalities
Rash - up to 20%
Visual disturbances commonly associated with treatment, usually reversible with duration of use < 28 days.
Many via CYP450- suggest review interactions with pharmacist.
Risk when combining with other QTc prolonging agents
Antimicrobial class: Triazole antifungal, second generation
Average serum half life: Variable and dose dependent.
Route of Elimination: Urine (<2% as unchanged drug)